Beneficial Effects of a Combined Navigator/Promotora Approach for Hispanic Women Diagnosed with Breast Abnormalities

Abstract

Background Patient navigation (PN) is an emerging strategy to overcome barriers to cancer care. We evaluated the efficacy of PN in improving time of key events in cancer care, including positive screening tests, definitive diagnosis, initiation of therapy, and completion of initial therapy. Methods We evaluated PN in a prospective observational study of predominantly poor Hispanic women with an abnormal breast cancer screening or untreated biopsy proven breast cancer (control = 200, intervention = 260). Controls were contemporary records-based patients with positive screening. Analyses were conducted for the entire cohort and separately by ethnic strata. We used Chi-Square tests to compare differences in proportions and Kaplan-Meier followed by Cox Regression to compare time-to-event curves of the intervention and control groups. Results The average days from definitive diagnosis to initiation of therapy was significantly reduced overall with PN (PN vs control, 57d vs 74d, p=.04). This effect was more pronounced in the Hispanic strata (56 vs 81 days, p=.02). More navigated Hispanic women were diagnosed within 60 days of abnormal screening (62.6% vs 47.5%, p< .01) and more began treatment within 60 days of diagnosis (80% vs 56.3%, p<.01). Navigated Hispanic and other ethnic minority women had a shorter time from positive screening test to definitive diagnosis (16 and 32 days, respectively). Conclusions Minority women may have benefitted from navigation with shorter times from definitive diagnosis to initiation of therapy.. Impact PN intervention may show promise in decreasing some delays that contribute to health disparities among minority women with breast cancer.

Impact of Patient Navigation Interventions on Timely Diagnostic Follow Up for Abnormal Cervical Screening

“…Women were excluded if they were pregnant or had a history of cancer treatment within the last 5 years. 11 The San Antonio Patient Navigation Research Program employed a novel partnership of navigators and promotoras, defined as lay community health workers who were members of the Hispanic community. Two navigators addressed barriers to medical care, while one promotora addressed cultural barriers to care.…”

“…10 Patient navigators may serve an important role in eliminating healthcare barriers to assist patients in obtaining timely care. 5,6,11,12 Therefore, the current study evaluated the effect of patient navigation on timely diagnostic follow-up for women with cervical abnormalities at four of the nine institutions (Boston, Ohio, Chicago, and San Antonio) that recruited this population. We hypothesized that women with cervical abnormalities assigned to patient navigation would have more timely diagnostic follow-up of their abnormality and this effect would be evident across all abnormality types and socioeconomic status/demographic levels.…”

Multiple Barriers Delay Care Among Women with Abnormal Cancer Screening Despite Patient Navigation

“…4,16 Indeed, mounting evidence documents the benefits of navigation on the delivery of timely, quality cancer care. [17][18][19][20][21] Despite increasing adoption of navigation practices, there is limited understanding of the impact of barriers to care on clinical outcomes within patient navigation programs.…”

Patterns of task and network actions performed by navigators to facilitate cancer care

“…Health care organizations, especially those identified as ''safety net'' providers of care, have deployed patient navigators, assigning them the tasks of identifying patients at risk of poor access, mitigating the barriers they face, and facilitating provision of care, navigating them to needed cancer care. Recent reports from the national patient navigation research program (PNRP) provide evidence of the effectiveness of this strategy to improve timely care after abnormal cancer screening (Battaglia et al, 2012;Dudley et al, 2012;Fiscella et al, 2012;Hendren et al, 2012;Hoffman et al, 2012;Markossian, Darnell, & Calhoun, 2012;Paskett et al, 2012;Raich et al, 2012;Wells et al, 2012).…”